Active NPI
Bernard Ty, FNP
- Nurse Practitioner
- Los Angeles, CA
National Provider Identifier
1396120614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 95002756
- Practice address
- 3920 Edenhurst Ave
Los Angeles, CA 90039-1616 - Phone
- (323) 868-2588
- NPI assigned
- Jul 28, 2015
- Last updated
- Jul 28, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 95002756 | CA | Primary |
Addresses
Primary practice location
3920 Edenhurst Ave
Los Angeles, CA 90039-1616
Mailing address
3920 Edenhurst Ave
Los Angeles, CA 90039-1616
Phone (323) 868-2588
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 95002756 | CA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438041600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1438041600000",
"number": "1396120614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3920 EDENHURST AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900391616",
"telephone_number": "323-868-2588"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3920 EDENHURST AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900391616",
"telephone_number": "323-868-2588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TY",
"first_name": "BERNARD",
"credential": "FNP",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-07-28",
"last_updated": "2015-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "CA",
"license": "95002756",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.